Wednesday, July 27, 2016

Here We Go Again!

Melanoma is one of the deadliest forms of cancer. It is a skin cancer and it multiplies and metastasizes at a phenomenal rate. Back when I first started to study this in the 1960s it presented as an already metastasized lesion. I saw mothers and young people die in a most horrific fashion.

Then along came skin exams. By a dermatologist using a dermatoscope one can get a fairly good assessment of the malignant potential while still in early and curable stages. namely skin exams really do save lives. They are cheap, and skin biopsies are also somewhat inexpensive.

Now along come our friends at the USPSTF, the same crew that has been opining on prostate cancer. In JAMA they state:

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults...

That's right folks, don't do those skin screenings, just wait till there is a spreading bleeding lesion that stains your shirts and then perhaps you should see someone! But, wait, there is nothing we can do then, so just go home and die.

Don't we just love these folks!

Now read this one on the harms:

Evidence is adequate that visual skin examination by a clinician to screen for skin cancer leads to harms that are at least small, but current data are insufficient to precisely bound the upper magnitude of these harms. Potential harms of skin cancer screening include misdiagnosis, overdiagnosis, and the resulting cosmetic and—more rarely—functional adverse effects resulting from biopsy and overtreatment.

The harms are negligible. You want patients to be aware and to see someone before it gets to where it was in 1964! Back then we just about wrote people off. 

They state:

Melanoma mortality rates for men and women in the Schleswig-Holstein region of Germany, which participated in the Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany (SCREEN) study, as compared with the whole of Germany. The original SCREEN study reported a relative 48% reduction in melanoma mortality (or 1 fewer death per 100 000 screened) resulting from a program of 1-time clinical visual skin cancer screening combined with a disease awareness campaign.  

 I have heard the author speak several time. The problem with the result is several fold. First is is northern Germany, not Miami! Second, Germany has limited the number of Dermatologists so that screening is at best problematic due to access. The payment by German Health Authorities is de minimus. 

Thus if the data is not there then go get it folks. Instead this group just like stopping all Health Care!

One wonders when one looks towards the NCI and their recent warning to people:

In the trial, patients and their skin-check partners who received training in how to find and track suspicious moles over time found substantially more early-stage melanomas than pairs who only received reminders from their doctors to perform regular skin self-examinations. The training also reduced the worry often felt by patients who are told to keep an eye on their skin but not offered detailed guidance, explained June Robinson, M.D., of the Northwestern University Feinberg School of Medicine and lead author of the study.

Here we have not physicians but family members! Apparently the NCI relies on clinical studies. Perhaps the USPSTF could learn something from this as well! They should check it out, there is this thing called the Internet and it has this thing called Google, try it folks!